Surgical Options for Failed Rotator Cuff Repair, except Arthroplasty: Review of Current Methods

Kim, Jangwoo; Ryu, Yunki; Kim, Sae Hoon

doi:10.5397/cise.2019.00416

Cited by 15 publications

(13 citation statements)

References 94 publications

(101 reference statements)

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confidence: 99%

“…Recently, the techniques and instrumentation used for surgical repair of torn rotator cuffs have rapidly improved, and the clinical and functional outcomes of rotator cuff repair have been satisfactory. 2,25 Nevertheless, large to massive RCTs are still a formidable and challenging problem, 18,26,43 and in some large to massive RCTs, the direct repair of the native rotator cuff tendons to the footprint of the greater tuberosity is impossible, even after adequate release, because of retraction, attenuation, and inelasticity of tendons. 4 Many surgical procedures have been introduced for the treatment of irreparable RCTs: arthroscopic debridement, 27 tuberoplasty, 16,54 partial repair, 3 interposition grafting (IG), 41,46 superior capsular reconstruction (SCR), 34 tendon transfers, 15,17 reverse total shoulder arthroplasty, 6,39,50 and arthrodesis.…”

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Clinical Outcomes of Interposition Graft Versus Superior Capsular Reconstruction in Patients With Irreparable Rotator Cuff Tears: A Systematic Review and Meta-analysis

Baek

Shin

Kim

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Interposition grafting (IG), also called bridging grafting, and superior capsular reconstruction (SCR) are the most commonly used joint-preserving surgical methods for irreparable rotator cuff tears (RCTs). Purpose: To compare the effectiveness of IG versus SCR to treat patients with irreparable RCTs. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search was performed in MEDLINE, Embase, and Scopus. Included in this review were clinical studies evaluating the effect of IG or SCR in patients with irreparable RCTs with a minimum follow-up of 1 year. Various clinical results from the studies were extracted and compared between IG and SCR, and among them, the results of the American Shoulder and Elbow Surgeons score, graft retear rate, and complication rate were included in the meta-analysis. Results: Of 1638 identified articles, 17 (10 studies of IG involving 321 patients and 7 studies of SCR involving 357 patients) were selected. Both surgical methods showed significantly improved clinical outcomes in all but 1 study; however, the IG group had lower pain visual analog scale score, higher Constant score, and bigger active forward flexion and internal rotation compared with the SCR group (all P < .001). The meta-analysis showed no difference in the American Shoulder and Elbow Surgeons score between groups ( P = .44), but showed a significantly lower complication rate in the IG group compared with the SCR group (1.12% vs 8.37%, respectively; P < .001). The graft retear rate was not significantly different between groups (IG = 10.64% vs SCR = 12.67%; P = .79). The meta-analysis of graft type indicated no difference between groups in retear rate (autograft: 95% CI, 0.045-0.601; I2 = 93.28 [IG], 91.27 [SCR]; P = .22; allograft: 95% CI, 0.041-0.216; I2 = 80.39 [IG], 69.12 [SCR]; P = .64) or complication rate (autograft: 95% CI, 0.009-0.150; I2 = 0 [IG], 65.89 [SCR]; P = .25; allograft: 95% CI, 0.012-0.081; I2 = 0 [IG], 30.62 [SCR]; P = .09). Conclusion: Both IG and SCR techniques resulted in improvement in patients with irreparable RCTs. Meta-analysis showed a lower complication rate in the IG group; however, the lack of randomized studies limited our conclusions.

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Clinical Outcomes of Interposition Graft Versus Superior Capsular Reconstruction in Patients With Irreparable Rotator Cuff Tears: A Systematic Review and Meta-analysis

Baek

Shin

Kim

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…26 Although surgical techniques and instrumentation have developed considerably in the past years, the failure rate of rotator cuff healing after repair is still high and an unsolved problem. 11,15,22,25 Transforming growth factor beta 1 (TGF-b1) is a protein that performs many cell functions, including the control of cell growth, cell proliferation, cell differentiation, and apoptosis. 4,36 Previous studies have shown that TGF-b1 is a major mediator in the healing phase, facilitating collagen production, angiogenesis, and extracellular matrix formation.…”

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Effect of a Porous Suture Containing Transforming Growth Factor Beta 1 on Healing After Rotator Cuff Repair in a Rat Model

et al. 2021

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Background: The healing failure rate after rotator cuff repair is considerably high. Purpose: To evaluate the effect of a porous suture containing transforming growth factor beta 1 (TGF-β1) on the sustained release of TGF-β1 and rotator cuff healing in a rat model. Study Design: Controlled laboratory study. Methods: A porous suture was developed, and its tensile strength was measured. TGF-β1 was delivered using the porous suture, and a TGF-β1 release test and human fibroblast proliferation assay were performed. For the animal experiment, 30 rats were randomly allocated into 3 groups (n = 10 each). A bilateral supraspinatus tendon tear was made in all the rats, and repair was performed. Group 1 received repair only; group 2, repair and a single injection of TGF-β1; and group 3, repair using the porous suture containing TGF-β1. Eight weeks after repair, biomechanical and histological analyses were performed. Results: The porous suture was successfully developed with mechanical properties compatible with the conventional suture, and the sustained release of TGF-β1 from the porous suture was confirmed. In addition, the cell proliferation assay confirmed the biological safety of the porous suture. In the animal experiment, group 3 biomechanically exhibited the largest cross-sectional area and the highest ultimate failure load and ultimate stress (all P < .05). Histological examination revealed that group 3 showed significantly better collagen fiber density and tendon-to-bone maturation than did groups 1 and 2 (all P < .05). Conclusion: The porous suture containing TGF-β1 could sustainedly and safely release TGF-β1, and its use during rotator cuff repair could improve rotator cuff healing, as assessed on the basis of the biomechanical and histological changes in the rat model in this study. Considering the effectiveness, safety, and convenience of the porous suture without extra effort in surgery, the findings of the present study will have a far-reaching effect on the treatment of rotator cuff tears. Clinical Relevance: The porous suture containing TGF-β1 might improve healing after rotator cuff repair.

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“…For these reasons, MRI is the investigation of choice to evaluate a suspected re-tear following rotator cuff repair. 42…”

Section: Investigationmentioning

confidence: 99%

Re-tears after rotator cuff repair: Current concepts review

Mandaleson

2021

Journal of Clinical Orthopaedics and Trauma

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Re-tear following rotator cuff repair is common and has been reported to range from between 13 and 94% despite satisfactory clinical outcomes following rotator cuff surgery. Various risk factors have been associated with an increased tear rate, including patient factors, tear and shoulder morphology, repair technique, and rehabilitation regimes. Different modes of rotator cuff failure have been described. The management of re-tear in patients following rotator cuff repair is challenging and depends on the age, functional status and requirements of the patient, and re-tear size and residual tendon length. This article aims to review the factors associated with rotator cuff re-tear. It describes which of these are associated with poor clinical outcomes, and discusses the long-term outcomes of re-tear and treatment options.

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Surgical Options for Failed Rotator Cuff Repair, except Arthroplasty: Review of Current Methods

Cited by 15 publications

References 94 publications

Clinical Outcomes of Interposition Graft Versus Superior Capsular Reconstruction in Patients With Irreparable Rotator Cuff Tears: A Systematic Review and Meta-analysis

Clinical Outcomes of Interposition Graft Versus Superior Capsular Reconstruction in Patients With Irreparable Rotator Cuff Tears: A Systematic Review and Meta-analysis

Effect of a Porous Suture Containing Transforming Growth Factor Beta 1 on Healing After Rotator Cuff Repair in a Rat Model

Re-tears after rotator cuff repair: Current concepts review

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